title: Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors.
abstract: OBJECTIVE
  To determine the optimum combination strategy of transcatheter arterial chemoembolization and radiofrequency (RF) ablation in an experimentally induced hepatic tumor model.
  
  
  METHODS
  Twenty-five New Zealand White rabbits with VX2 carcinoma-induced hepatic tumors were randomly divided into five treatment groups, which received (i) chemoembolization followed 15 minutes later by RF ablation; (ii) RF ablation followed by chemoembolization; (iii) chemoembolization alone; (iv) RF ablation alone; and (v) bland embolization followed by RF ablation. Animals were euthanized at 48 hours to determine tumor infarction and coagulation, which were compared with analysis of variance. Representative histopathologic slides were compared.
  
  
  RESULTS
  Significantly larger areas of coagulation were produced by chemoembolization followed by RF ablation (22.0 cm(3) +/- 7.7) compared with RF ablation followed by chemoembolization (13.1 cm(3) +/- 3.2) and RF ablation alone (10.0 cm(3) +/- 4.5; P < .05). RF ablation followed by chemoembolization showed larger treatment areas than chemoembolization alone (25.0 cm(3) +/- 9.6 vs 12.1 cm(3) +/- 4.6; P < .001), with chemotherapeutic agent preferentially depositing around the coagulation zone. Histopathologic analysis revealed greater vascular thrombosis and necrosis and reduced islands of viable tumor cells in the chemoembolization/RF ablation group versus the groups treated with chemoembolization alone or bland embolization/RF ablation.
  
  
  CONCLUSIONS
  Larger treatment volumes were produced when chemoembolization was performed before RF ablation than when RF ablation preceded chemoembolization or when RF ablation or chemoembolization were performed alone. Larger treatment volumes were also produced when chemoembolization rather than bland embolization was performed before RF ablation, indicating the importance and synergy of the chemotherapeutic regimen. These results suggest that the reduction of tumor blood flow combined with the effect of hyperthermia and local chemotherapy creates the largest dimensions of treatment.
authors.affiliation: Department of Radiology and Minimally Invasive Tumor Therapy Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Elian M
authors.initials: EM
authors.lastname: Mostafa
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
authors.forename: Salomao
authors.initials: S
authors.lastname: Faintuch
authors.forename: Pawel
authors.initials: P
authors.lastname: Mertyna
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D000818:Animals; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001777:Blood Coagulation; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005780:Gelatin / Q000008:administration & dosage; D008114:Liver Neoplasms, Experimental / Q000097:blood / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009336:Necrosis; D009368:Neoplasm Transplantation; D011817:Rabbits; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D000180:Acrylic Resins; D000903:Antibiotics, Antineoplastic; C496735:trisacryl gelatin microspheres; D004317:Doxorubicin; D005780:Gelatin